A revisionist model for treatment-resistant and difficult-to-treat depression.

IF 4 2区医学 Q1 PSYCHIATRY

Australian and New Zealand Journal of Psychiatry Pub Date : 2024-06-01 Epub Date: 2024-03-27 DOI:10.1177/00048674241240600

Gordon Parker

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引用次数: 0

Abstract

Objective: The aim of this study is to consider limitations to the heuristics 'treatment-resistant depression' (TRD) and 'difficult-to-treat' depression (DTD) and to offer a revisionist model.

Methods: A number of limitations to the two constructs are noted, particularly the risk of each positioning clinical depression as an entity and then applying a linear sequencing management model.

Results: Arguing that clinical depression is heterogenous in nature (with categorical and 'fuzzy set conditions), in cause and in response to treatment, allows an alternate model for addressing depressive conditions that are not readily responsive to treatment. A skeletal model for proceeding is offered for consideration and development.

Conclusion: If such a model is accepted, then differing criteria for defining treatment resistance and treatment failure might be generated for differing depressive conditions, and condition-specific sequencing algorithms (embracing drug and non-drug strategies) developed for their management.

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治疗耐药和难治抑郁症的修正主义模式。

目的：本研究旨在考虑 "治疗耐受性抑郁症"（TRD）和 "难治性抑郁症"（DTD）启发式疗法的局限性，并提供一个修正主义模型：本研究旨在探讨 "耐药抑郁症"（TRD）和 "难治抑郁症"（DTD）这两个启发式概念的局限性，并提供一个修正主义模型：方法：指出了这两个概念的一些局限性，尤其是将临床抑郁症定位为一个实体，然后采用线性排序管理模式的风险：结果：认为临床抑郁症在性质上（具有分类和 "模糊集合条件"）、病因上和对治疗的反应上都是异质的，因此可以采用另一种模式来处理不容易对治疗做出反应的抑郁状况。本文提出了一个可供参考和发展的骨架模型：结论：如果这种模式被接受，那么就可以针对不同的抑郁状况制定不同的标准来界定治疗耐受性和治疗失败，并制定针对具体状况的排序算法（包括药物和非药物策略）来进行管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Australian and New Zealand Journal of Psychiatry 医学-精神病学

CiteScore

8.00

自引率

2.20%

发文量

149

审稿时长

6-12 weeks

期刊介绍： Australian & New Zealand Journal of Psychiatry is the official Journal of The Royal Australian and New Zealand College of Psychiatrists (RANZCP). The Australian & New Zealand Journal of Psychiatry is a monthly journal publishing original articles which describe research or report opinions of interest to psychiatrists. These contributions may be presented as original research, reviews, perspectives, commentaries and letters to the editor. The Australian & New Zealand Journal of Psychiatry is the leading psychiatry journal of the Asia-Pacific region.